Laserfiche WebLink
1 I <br /> Date run 5/14/2003 8:00:40AN SAN JOAN COUNTY ENVIRONMENTAL HEAL/ "DEPARTMENT Report#5021 <br /> Run by Pagel <br /> Facility Information as of 5/14/2003 <br /> Record Selection Criteria: Facility ID FA0012157 <br /> Make changes/corrections in RED ink or pencil. <br /> INFORMATION CHANGE(date) <br /> OWNERSHIP CHANGE(date) <br /> OWNER FILE INFORMATION <br /> Owner ID OW0004890 New Owner ID <br /> Owner Name POMBO, ERNEST J JR <br /> Owner DBA POMBO REAL ESTATE <br /> Owner Address 24100 S LAMMERS ROAD <br /> TRACY, CA 95376 <br /> Home Phone Not Specified <br /> Work/Business Phone Not Specified <br /> Mailing Address PO BOX 805 <br /> TRACY, CA 95376 <br /> Care of ERNEST J POMBO JR <br /> FACILITY FILE INFORMATION <br /> Facility ID FA0012157 <br /> Facility Name POMBO REAL ESTATE <br /> Location 1755 W 11TH ST <br /> TRACY, CA 95376 <br /> Phone 209-835-4949 <br /> Mailing Address PO BOX 805 <br /> TRACY, CA 95378 <br /> Care of ERNEST J POMBO JR <br /> Location Code 03-TRACY APN: 1 <br /> BOS District 005-ORNELLAS, LEROY SIC Code: <br /> ACCOUNTS RECEIVABLE FILE INFORMATION <br /> Account ID AR0019502 New Account ID: <br /> Mail Invoices to Account Mail Invoices to: Owner / Facility / Account <br /> Account Name CHEVRON-ENVIRONMENTAL MGMT CO (Circle one) <br /> Account Balance as of 5/14/2003: $0 00 <br /> (Circle One) <br /> Transfer to Activeflnactve <br /> Program/Element and Description Record ID Employee ID and Name Status New Owner? Delete <br /> I <br /> 2960-RWQCB CLEAN UP SITE(SLIC) PR0515454 EE0000684-MICHAEL INFURNA Active Y N A /!I,) D f <br /> BILLING and COMPLIANCE ACKNOWLEDGEMENT: I,the undersigned owner,operator or agent of same,acknowledge that all site,and/or project specific,PHS/EHD hourly charges associatedwith this <br /> facility or activity will be billed to the party identified as the OWNER on this form. I also certify that all operations will be performed in accordance with all applicable Ordinace Codes and/or Standards and <br /> State and/or Federal Laws. <br /> APPLICANT'S SIGNATURE: Date <br /> Program Records to be TRANSFERED: *$20.00= Amount Paid Date <br /> Water System to be TRANSFERED: *$155.00= Amount Paid Date <br /> Payment Type /-1 / Check Number Recelued by <br /> RENS: _J �' Date �� /V Account out�/h...��[Date 'AT—1 Jy:/ <br /> COMMENTS: <br /> [/ I <br /> V <br /> j <br /> ( ) <br /> \1Phs-ehsgl-nt\apps\Envisions\Reports\5021.rpt �+ f <br />